By :- AMATULLAH BHURKA (Final Year)

Gov. Physiotherapy College, Ahmedabad

Definition of
Parkinson’s
Disease
Epidemiology
PATHOPHYSIOLOGY
Causes of
Parkinsonism
Parkinson-plus
Syndromes
Four Primary
Symptoms of
PD
Other
Symptoms of
Parkinson’s
Disease
Other
Symptoms of
Parkinson’s
Disease
DIAGNOSIS
DIAGNOSIS
 Stage 0 No signs of disease
Stage 1 Unilateral disease
Stage 1.5 Unilateral disease plus axial involvement
Stage 2 Bilateral disease, without impaired balance
Stages of Stage 2.5 Bilateral disease, with impaired balance
PD Stage 3 Mild to moderate bilateral disease, some
postural instability; physically dependent
Stage 4 Severe disability; still able to walk or stand
unassisted
Stage 5 Wheelchair-bound or bedridden
Outcome
Measurements
 ➢ No cure currently exists
➢ Treatment does not stop the progression of the disease
➢ Offers symptomatic relief
Treatment of
➢ Can temporarily restore function
PD ➢ Can enhance Quality Of Life
➢ Each individual responds to drugs differently
 ➢ Mild symptoms may not require medication
➢ When prescription drugs are needed, they help to
manage symptoms, but cannot stop the progression
of the disease
PHARMACOLOGIC ➢ When a drug no longer effectively controls symptoms,
AL TREATMENT another drug may be added to existing therapy
➢ Optimal management is highly individualized and is
best determined by a doctor who specializes in the
treatment of PD
 Levodopa Converted to dopamine in the
bone, which is responsible for
transmitting signals in the brain
allowing for normal movements
Often combined with Carbidopa
MEDICATIONS (Sinemet), which ↑ the amount of
Levodopa that goes to the brain
COMT inhibitors Blocks the action of catechol-O-
methyltransferase, an enzyme that
breaks down dopamine.
Entacapone (Comtan) and
Tolcapone (Tasmar)
 Dopamine agonists Act like dopamine within the brain
Bromocriptine (Parlodel),
Pramipexole (Mirapex), Ropinirole
(Requip), and Apomorphine
(Apokyn)
MEDICATIONS
Amantadine Unknown mechanism; may ↑
brain’s response to dopamine or
releases stored dopamine
Amantadine (Symmetrel)
 Anticholinergics Exert a relaxing effect on the body
Benztropine Mesylate (Congetin),
Procyclidine (Kemadrin), Biperiden
(Akineton), and Trihexyphenidyl

MEDICATIONS
Selegiline Unknown mechanism
Appears to inhibit the breakdown of
dopamine
Usually added to a patient’s therapy
when effectiveness of Levodopa is ↓
Selegiline (Zalapar, Eldepyrl, Emsam)
Surgical
Management
Assessment
and
Evaluation
RIGIDITY
Bradykinesia
Bradykinesia
TREMOR
Balance
Evaluation
Gait
Evaluation
 FUNCTIONAL STATUS

FTSTS test
Patient specific functional
scale
FIM
PT
Management of
Parkinsionism
Management
of Rigidity
Relaxation
Techniques
Initiation of
Movement /
Akinesia
Facilitation of
Movement
Resting Tremor
Functional
Movement
Patterns
Balance
Training
Gait
Training
Gait
Training
Reducing
Freezing
 ➢ Focus on ROM, gait, balance, antirigidity, ADLs
➢ Leg strength – use equipment, resistive bands

Exercises ➢ Balance/sway – foam pads, retropulsion tests

➢ Strengthen trunk muscles for respiration and posture
➢ Weight shifting
➢ Exercises for transfers
 ➢ Stretching exercises essential
• Posterior direction: reaching backwards, walking
backwards
• Extension exercised
• Throwing/kicking a ball
Exercises • Push-ups; superman
➢ PROM
➢ PNF
➢ Respiration exercises
➢ Relaxation exercises – Yoga, Tai Chi
➢ Karate exercises – shown to ↓ tremors and ↑ dexterity
and coordination
• Energy Conservation
 ➢ The slow, rhythmic pace of functionally based
exercises, internal organ stimulation, flexibility
maintenance, balance training effects, and
Tai Chi general health benefits of Tai Chi
➢ Relevant to PD management: fall prevention,
tremor reduction, and motor control
Exercise
Programs
Dietary
Recommendations
 STRETCH REFLEX – TRAGER METHOD

➢ ↑ muscle rigidity hypothesized to be caused by

enhanced activity of a “long latency”
component of the stretch reflex
➢ Manual segmental vibration characteristic of
Stretch Reflex – the Trager method, consists of imparting low-
frequency movements to a limb to produce a
Trager Method brief but substantial reduction in the H-reflex
(stretch reflex)
➢ Suggests that imparting rocking motions to a
body segment can alter the activity of the
reflex pathways
 STRETCH REFLEX

➢ Trager Approach: imparts a series of very gently

painless, passive rocking motions to the limbs
➢ Significant reduction of evoked stretch
response was observed; may induce a reduction
Stretch Reflex
of the muscle rigidity seen in patients with PD
➢ More effective in supine than sitting